Posted by Brigham and Women's Hospital May 26, 2016

This year’s Boston Walk from Obesity winds through the Arnold Arboretum.

For years, Sheila Fitzgerald of Dedham, MA, has participated in the Walk from Obesity. Two years ago, she was among the top fundraisers in the country. Her focus last year, however, was more on raising awareness than raising money.

“I think it’s important to talk about obesity and educate people,” says Sheila.

She wants others to be more informed than she was. A lack of understanding is why it took her so long to consider weight loss surgery, she explains. The need for a knee replacement, however, pushed her to learn more about surgical options for weight loss.

Staying Active

Sheila has always been active, even when she was overweight. However, severe pain in her left knee caused her to cut back on her exercise. She sought counsel from Dr. Anthony Webber, an orthopedic surgeon at BWFH, who advised her that she should get a knee replacement. Otherwise, she would become sedentary – a prospect that she feared.

Despite being apprehensive about undergoing weight loss surgery, she signed up for an information session. She asked a lot of questions at the session and soon learned that weight loss surgery would be a sensible treatment for her obesity.

After being evaluated by Dr. Scott Shikora, Director of the CMBS, and other BWH specialists, it was determined that she would be a suitable candidate for a sleeve gastrectomy. This procedure involves removing the outer crescent of the stomach, an area where a major hormone that regulates appetite is produced. The procedure also reduces the capacity of the stomach to hold food by about 75 percent. Along with promoting weight loss, the sleeve gastrectomy is believed to be particularly effective at treating certain metabolic conditions, such as type 2 diabetes, high blood pressure, high cholesterol, fatty liver disease, and obstructive sleep apnea.

Dr. Shikora performed Sheila’s weight loss surgery in January 2014. Since that time, she has lost 80 pounds and no longer has sleep apnea. Those benefits also have come with no complications.

In November 2014, Dr. Webber performed Sheila’s knee replacement. Her knee feels great today, and she is back to being her active self.

Posted by Brigham and Women's Hospital April 19, 2016

Recent research suggests that peanut allergy can be prevented through the early introduction of peanut into a child’s diet.

Contributor: Joyce T. Hsu, MD, is a food allergy specialist at Brigham and Women’s Hospital and Instructor in Medicine at Harvard Medical School.

In only the last 13 years, the prevalence of peanut allergy in the U.S. has quadrupled. Recent research, however, strongly suggests that peanut allergy – now the nation’s leading cause of food allergy-related anaphylaxis and death – can be prevented through the early introduction of peanut into a child’s diet. According to Dr. Hsu, the Learning Early about Peanut Allergy (LEAP) study may represent the key to reversing our society’s disturbing food allergy trend.

“LEAP may be the most pivotal food allergy study for our generation,” says Dr. Hsu. “Since the results were released last year, we have been trying to increase awareness about this new thinking for peanut allergy.”

The former thinking, at least in this country, says Dr. Hsu, was that parents should avoid giving their children highly allergenic foods during the first few years of life. In 2000, the American Academy of Pediatrics (AAP) recommended that children deemed to be at risk of developing food allergy not eat peanuts until the age of three. However, cases of peanut allergy continued to rise, and the AAP withdrew its recommendation in 2008. Read More »

Posted by Brigham and Women's Hospital March 31, 2016

Patients and caregivers should weigh the expected benefits with the potential risks of a contralateral (double) prophylactic mastectomy.

A recent Brigham and Women’s (BWH) study reveals that from 2002 to 2012, the number of women choosing to have both of their breasts removed as a strategy to prevent the recurrence of breast cancer – a procedure known as contralateral prophylactic mastectomy (CPM) – tripled in the U.S., but without a corresponding improvement in survival. Researchers note that while CPM may have a survival benefit for patients that are at high risk of developing breast cancer, such as those with a genetic mutation, the majority of women undergoing CPM are at low risk for developing breast cancer in the unaffected breast.

“Our analysis highlights the sustained, sharp rise in popularity of CPM, while contributing to the mounting evidence that this more extensive surgery offers no significant survival benefit to women with a first diagnosis of breast cancer,” says senior author Dr. Mehra Golshan, Distinguished Chair in Surgical Oncology at BWH. “Patients and caregivers should weigh the expected benefits with the potential risks of CPM, including prolonged recovery time, increased risk of operative complications, cost, the possible need for repeat surgery, and effects on self image.”

Posted by Brigham and Women's Hospital March 22, 2016

Most urgent care centers can handle many of the bumps, bruises, and minor illnesses that previously were only seen in an emergency department.

Your daughter just twisted her ankle while playing outside, and her foot and ankle have become quite swollen. Are you unsure about whether to bring her to an emergency department (ED) or to an urgent care center? Either option is appropriate, but you might be surprised to learn that most urgent care centers can handle many of the bumps, bruises, and minor illnesses that previously were only seen in the ED.

Dr. Calvin A. Brown III, Medical Director of the Urgent Care Center at Brigham and Women’s/Mass General Health Care Center in Foxborough, says that the recent advent of urgent care centers has created a valuable health care resource. They help patients who desire – and probably need – immediate, same-day care, but who aren’t able to get an appointment with their primary care physician and wish to avoid a trip to the ED. The wide variety of medical issues that urgent care center clinicians can treat include sprains, simple fractures, small lacerations, abscesses, bronchitis, asthma attacks, allergies, urinary tract infections, ear infections, low-grade pneumonia, concussions, and many other conditions.

Posted by Brigham and Women's Hospital March 17, 2016

The likelihood of a patient getting a PSA test for the early detection of prostate cancer may depend on the type of physician he sees.

Dr. Quoc-Dien Trinh is a urologist at Brigham and Women’s Hospital (BWH).

Recent research led by Brigham and Women’s Hospital suggests that the likelihood of a patient getting prostate-specific antigen (PSA) testing for the early detection of prostate cancer depends on the type of physician he sees.

In October 2011, the U.S. Preventive Services Task Force (USPSTF) issued a recommendation against the use of PSA testing for prostate cancer screening for all men. In its assessment, the task force concluded that, overall, the harms of PSA testing outweigh its benefits. The study authors, however, hypothesized that adoption of the USPSTF recommendation would vary according to a physician’s specialty.

The researchers examined PSA testing use among primary care physicians (PCPs) and urologists in the year immediately before the recommendation was issued and the year immediately afterward. To focus on preventive care visits, men previously diagnosed with prostate cancer, an elevated PSA level, or other prostate conditions were excluded from the study.

The study found that PSA testing for men aged 50-74 years decreased significantly from 36.5 percent in 2010 to 16.4 percent in 2012 among PCPs. However, during those same years, such testing among urologists only decreased from 38.7 percent to 34.5 percent.

Posted by Brigham and Women's Hospital March 3, 2016

A recent study found that only 34 percent of adults were counseled about physical activity during their last primary care visit.

Has your doctor ever given you a prescription for exercise?

Dr. JoAnn Manson, Chief of the Division of Preventive Medicine at Brigham and Women’s Hospital, recently co-authored an article that calls for physicians and other health care professionals to make exercise counseling a consistent component of their interactions with patients. Failure to do so, explains Dr. Manson, is a lost opportunity to safely and inexpensively improve the health of patients.

“There is a consensus within the medical and public health communities that increasing physical activity among our patients should be a priority,” says Dr. Manson. “No other single intervention or treatment is associated with such a diverse array of benefits.”

Among those benefits is reducing the risk for major chronic diseases, including high blood pressure, type 2 diabetes, obesity, heart disease, stroke, cognitive decline, certain cancers, and depression.

A recent study, however, found that only 34 percent of adults were counseled about physical activity during their last primary care visit. Among adults with vascular risk factors, about 40 percent received such counseling. Dr. Manson and her co-authors suggest that this lack of guidance may be due to time constraints, a lack of useful tools, or skepticism about the impact of exercise counseling.

Posted by Brigham and Women's Hospital February 23, 2016

Anticoagulants are most commonly used to treat patients with atrial fibrillation, a type of irregular heart rhythm.

Anticoagulants (blood thinners) are medications that are used to treat several types of cardiovascular conditions. They are commonly used to treat patients with atrial fibrillation, a type of irregular heart rhythm, and also to help patients with mechanical heart valves or those who have had blood clots in either their veins or arteries.

For many years, warfarin (Coumadin®) was the only anticoagulant treatment option available. In recent years, however, several new types of blood thinners have been shown to be effective and safe, including dabigatran, rivaroxaban, apixaban, and edoxaban. These additional options are significant, as they can be preferable to warfarin in certain cases. The advantages of these newer drugs over warfarin include decreased risk of bleeding, no need for routine laboratory monitoring, and fewer interactions with foods and other drugs. The newer drugs, however, also have some limitations when compared with warfarin. These newer medications, for instance, are short-acting (having effects that last for a short time), which can create problems for patients who have issues with adherence (taking medications as prescribed). It also is easier to reverse the effects of warfarin when patients have a bleeding complication or overdose on their anticoagulant medication.

Posted by Brigham and Women's Hospital February 18, 2016

The artificial meniscus stays in place without being attached to bones or any other surrounding tissue.

Injury to the meniscus is one of the most common knee-related ailments and is often accompanied by pain, swelling, and difficulty with knee function. Many patients with this problem will be able to regain normal function through a variety of well-known treatments. For those who aren’t that fortunate, Brigham and Women’s Hospital (BWH) orthopedic surgeon, Dr. Andreas Gomoll, is working to offer an alternate solution.

Dr. Gomoll recently became the first physician in New England to perform a new type of knee surgery that replaces a patient’s damaged meniscus with an artificial implant made from synthetic polymers (plastics). The procedure is being offered to certain patients as part of a clinical trial studying the experimental device’s effectiveness at relieving pain and restoring function in the knee.

The artificial meniscus is inserted into a patient’s knee through a small incision (two to three inches). Because of its special design, featuring a thick rim and a thinner center, the device stays in place – even when squatting – without being attached to bones or any other surrounding tissue. Over time, the implant molds itself to the patient, creating a secure, comfortable shock absorber for the knee. This design is a significant advance from a similar approach that uses a metal device, which, due to its hardness, doesn’t provide shock absorption or mold itself to the patient’s anatomy.

Posted by Brigham and Women's Hospital January 26, 2016

BWH research suggests that certain heart failure patients may extend their life by switching medications.

Contributor: Scott D. Solomon, MD is Director of Noninvasive Cardiology and Edward D. Frohlich Distinguished Chair in Cardiovascular Pathophysiology at Brigham and Women’s Hospital and Professor of Medicine at Harvard Medical School. His interests include cardiovascular disease and heart failure.

New Brigham and Women’s Hospital (BWH) research suggests that certain heart failure patients may extend their life by switching medications. The BWH-led study finds that patients with reduced ejection fraction (reduced ability to pump blood from the heart) can expect to live one-and-a-half to two years longer when treated with sacubitril-valsartan instead of enalapril, the current standard of care in heart failure.

Heart failure, the leading cause of hospitalization for Americans over the age of 65, accounts for more than one million hospitalizations in the U.S. each year. About half of the nearly six million Americans living with heart failure have the reduced ejection fraction form of the disease, which bears a significantly increased risk for future cardiac events and death.

Posted by Brigham and Women's Hospital January 5, 2016

About 30 to 40 million people in the United States annually complain of frequent heartburn and indigestion, a chronic condition that we describe as gastroesophageal reflux disease (GERD). GERD is characterized by regular reflux – the regurgitation of acid and other stomach content into the esophagus. Other symptoms may include difficulty swallowing, coughing, and chest pain.

Although less common, there are several other types of esophageal disorders, and their symptoms sometimes mimic those of GERD. These conditions may be caused by a lower esophageal sphincter (the muscular ring between the esophagus and the stomach) that fails to relax, a weak esophagus wall, poorly coordinated contractions of the esophagus, a narrowing of the esophagus, or tumors.